2025 CPT code 68320
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Conjunctivoplasty with conjunctival graft or extensive rearrangement.
Modifiers may be applicable depending on the circumstances of the procedure and payer requirements. Examples include modifiers for multiple procedures (51), bilateral procedures (50), or to indicate a reduced service (52).Consult the most recent CPT modifier guidelines for details.
Medical necessity for conjunctivoplasty is established when a patient presents with symptomatic conjunctival pathology that impairs vision or causes significant discomfort. This could include conditions like conjunctivochalasis, significant cicatricial changes, or defects following trauma or surgery. Documentation supporting the medical necessity for the procedure should include patient symptoms, visual acuity measurements, and photographs or other imaging to depict the severity of the condition.
The ophthalmologist or oculoplastic surgeon is responsible for performing the conjunctivoplasty.This includes pre-operative assessment, surgical planning and execution, post-operative care, and follow-up monitoring.Anesthesiologists may be involved in administering anesthesia as needed.Other healthcare professionals may assist during the surgical procedure.
In simple words: This surgery repairs the thin lining covering the inside of your eyelids and the white part of your eye. The doctor may use a piece of your own tissue to repair a damaged area or carefully rearrange the existing tissue to fix the problem. This is often done to treat a condition causing excess folds of this lining, which can be painful.
Conjunctivoplasty is a surgical procedure involving the repair of the conjunctiva, the membrane lining the inner surface of the eyelids and covering the sclera (white part of the eye).This CPT code, 68320, specifically addresses procedures where a conjunctival graft is used or the existing tissue is extensively rearranged to achieve repair. The procedure may involve excision of a portion of the conjunctiva to alleviate excess folds (e.g., in conjunctivochalasis), followed by grafting or tissue rearrangement to close the wound. The surgeon may utilize sutures or tissue adhesive to secure the graft or repositioned tissue.
Example 1: A patient presents with symptomatic conjunctivochalasis, characterized by redundant folds of conjunctiva causing irritation and blurred vision.The surgeon performs a conjunctivoplasty with extensive rearrangement of the conjunctival tissue to remove the excess folds and restore normal conjunctival anatomy. No graft is necessary., A patient has undergone pterygium excision with the creation of a significant conjunctival defect.The surgeon performs a conjunctivoplasty using a harvested autologous conjunctival graft to close the defect and promote healing.This would include harvesting the graft as an integral part of the 68320 procedure., A patient experiences a severe chemical burn leading to a large conjunctival defect requiring extensive reconstruction. The surgeon performs conjunctivoplasty with the use of a harvested autologous conjunctival graft to restore the integrity and function of the conjunctiva, potentially requiring multiple layers of grafts and meticulous suture placement.
Thorough preoperative assessment with documentation of the patient's symptoms, visual acuity, and extent of conjunctival involvement.Detailed operative report describing the surgical technique, including size and location of any excision, type and size of any graft used, and suture or adhesive materials employed. Postoperative assessment and documentation of wound healing, visual acuity changes, and any complications.
** Accurate coding requires detailed documentation of the surgical procedure, including the extent of tissue resection, type of graft used (if any), and the techniques employed for repair.The use of loupe magnification or operating microscope should be documented.Proper documentation is crucial to avoid denials and ensure accurate reimbursement.
- Revenue Code: P4E (EYE PROCEDURE - OTHER)
- RVU: The relative value units (RVUs) for CPT code 68320 vary depending on the specific geographic location, facility type (inpatient vs. outpatient), and payer.Consult your local fee schedule or payer-specific information for the most accurate RVU values and reimbursement rates.
- Global Days: The global period for 68320 is not explicitly defined in standard CPT documentation.The length of the global surgical period would depend on payer-specific policies and local practice guidelines.Additional post-operative visits or services may be separately reported depending on medical necessity.
- Payment Status: Active
- Modifier TC rule: No specific Technical Component (TC) modifier is typically used with 68320.The professional component (26) may be utilized for billing purposes, dependent upon payer requirements and specific billing practices.
- Fee Schedule: Historical fee schedules for CPT code 68320 are not readily available in this context. Fee schedules vary significantly by payer, location, and time period.Access to specific historical data requires consultation of relevant historical billing records or fee schedule databases.
- Specialties:Ophthalmology, Oculoplastics
- Place of Service:Office, Ambulatory Surgical Center, Hospital Outpatient Department